Why is it important to use x-ray, or radiographic imaging, while evaluating a child for child abuse?

It is important to use imaging studies to identify present and past skeletal injuries that a victim of child abuse may have suffered. For infants and small children, health care providers may order skeletal surveys to identify past and present skeletal injuries. Health care providers may order a skeletal survey and then repeat the study again two weeks later. This is because acute fractures may be occult or missed on the first study, but then evidence of a healing occult or missed fracture may be found on the second skeletal survey.
High resolution images are used to avoid a missed diagnosis. Providers generally order multiple views of the chest including anterior and posterior with oblique views of the ribs, two skull views, lateral views of the entire spine, anterior and posterior views of the pelvis, arms, hands, legs, and feet. One x-ray view of any body part is not acceptable.  
Evidence of child abuse is generally present when fractures are correlated clinically and found to involve the ends of long bones in non-ambulatory infants, multiple fractures or fractures in various phases of healing in any child, fractures associated with intracranial bleeds and depressed skull fractures.     
Christopher Keane
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California Child Abuse and Child Injury Lawyer